What's the Diagnosis - Case 33

History 46 year old man with recent weight lifting injury and deformity on exam.

What’s the Diagnosis - Case 33

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Findings Radiographs demonstrate a soft tissue prominence at the level of the mid humerus. On the MR exam, there is a profound amount of edema seen in the soft tissue anteriorly. There is an anterior tendon that is thickened and wavy and discontinuous.

A small stump of a tendon is seen at the radial tuberosity.

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Diagnosis: Distal Biceps Rupture Distal avulsion of the biceps tendon from the radial tuberosity typically occurs in middle aged men who participate in weight lifting. The mechanism is typically eccentric contraction against the flexed elbow where the patient feels a snap or tearing sensation followed by soft tissue swelling at the level of the humerus. The soft tissue swelling relates to muscle retraction as well as soft tissue injury and given the prominence is often identified as a “Popeye” sign. Without repair, the injury can result in prominent weakness of flexion and supination.

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Resources

• Repair of the ruptured distal biceps tendon: a systematic review. Chavan PR, Duquin TR, Bisson LJ. Am J Sports Med. 2008 Aug;36(8):1618-24.

Review.

• Distal biceps rupture. Mazzocca AD, Spang JT, Arciero RA. Orthop Clin North Am. 2008 Apr;39(2):237-49, vii. Review.

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